Morphological changes to peripheral joints supporting thumb trapezial metacarpal osteoarthritis.

The present study aims to determine if morphological differences of the scaphoid, trapezoid, and second metacarpal are associated with thumb osteoarthritis by comparing three-dimensional bone models of healthy controls and osteoarthritis patients. Fifty-eight patients with moderate to severe thumb osteoarthritis (modified Eaton ≥ II) and 35 healthy controls from a larger completed investigation were examined. To quantify morphological variations, a statistical shape model was created that classified binary with respect to the Eaton grading system: non-osteoarthritis or moderate/severe osteoarthritis (II-IV).

Personal Finance: Basic Instruments, Taxation Strategies, & Unique Opportunities.

The authors provide a simple primer for hand surgeons to further educate themselves on the basics of investing, tax reduction strategies that are completely legal, insurance protection, especially in your formative years, and unusual options available for further consideration. There are many ways for further education including publications related to finance, investment clubs of like-minded individuals, mentors that have extensive experience in these areas, and formal courses sponsored by business schools or other venues. The opportunities and regulatory environment are ever-changing, so one needs to constantly keep up with taxation rules and newer investment options.

Proximal Interphalangeal Joint Arthroplasty for Fracture.

Proximal interphalangeal joint arthroplasties can be performed in the setting of acute comminuted fracture, chronic fracture presentations, and posttraumatic arthritis. These surgeries provide excellent pain relief and patient satisfaction but patients should be cautioned not to expect an improvement in motion postoperatively. Despite high rates of minor complications and radiographic loosening, these implants have good rates of long-term survival with most revisions occurring in the early postoperative period.

A review of wear debris in thumb base joint implants.

Aim: Polymers and metals, such as polyethylene (PE) and cobalt chrome (CoCr), are common materials used in thumb-based joint implants, also known as CMC (Carpometacarpal) arthroplasty. The purpose of this review was to investigate the reported failure modes related to wear debris from these type of materials in CMC implants. The impact of wear debris on clinical outcomes of CMC implants was also examined.

The JAY (Joint Active Yoke) orthosis for a complex pip fracture-dislocation with failed volar plate repair: A case report.

Introduction: This case report details the postsurgical rehabilitation and outcome of a 57-year old neurosurgeon who underwent hemi-hamate arthroplasty and volar plate repair for a complex ring finger proximal interphalangeal (PIP) fracture-dislocation sustained after a fall while snowboarding. Following re-rupture and repair of his volar plate, the patient was fitted for a "yoke" relative motion flexor orthosis, termed a JAY (Joint Active Yoke) orthosis, in a manner reverse to that which is commonly used for extensor-related injuries.

Study Design/methods: A 57 yo right hand-dominant male who suffered a complex PIP fracture-dislocation with failed volar plate repair undwent hemi-hamate arthroplasty and early active motion following using a custom-fabricated joint active yoke orthosis.

Bone morphological changes of the trapezium and first metacarpal with early thumb osteoarthritis progression.

Background: Thumb carpometacarpal osteoarthritis is characterized by osteophyte growth and changes in the curvature of the articular surfaces of the trapezium and first metacarpal. The aim of this longitudinal study was to quantify in-vivo bone morphology changes with osteoarthritis progression.

Methods: The study analyzed an observational dataset of 86 subjects with early thumb osteoarthritis and 22 age-matched asymptomatic controls.

Characterization of Trapezial Pommel in Relation to Radiographic and Wear Patterns in Carpometacarpal Osteoarthritis.

Background: Trapezial pommel, or ulnar osteophyte positioned at the vertex of the saddle-shaped facet, is a consistent structural appearance in osteoarthritis (OA) of the first carpometacarpal. This study investigates its relation to radiographic measures (modified Eaton staging and thumb OA [ThOA] index) and wear patterns (trapezial surface morphology and cartilaginous eburnation).

Methods: In all, 137 whole trapezia were explanted from 116 patients and evaluated for Eaton staging, morphology (saddle, cirque, or dish), and eburnation (degree of cartilaginous effacement) of the articular surface of the trapezium.

Radiocarpal Fusion: Indications, Technique, and Modifications.

Degenerative disorders of the wrist may affect isolated joints and inhibit normal functions of the wrist secondary to pain and stiffness. These processes that affect only the radiocarpal joint may be secondary to posttraumatic osteoarthritis, primary osteoarthritis, or rheumatoid arthritis. Radiocarpal wrist arthrodesis may help preserve some of the native wrist kinematics while alleviating pain and improving the range of motion.

Evaluation of the PROMIS Upper Extremity Against Validated Patient-Reported Outcomes in Patients With Early Carpometacarpal Osteoarthritis.

Purpose: Internal consistency, construct, and criterion validity of the Patient-Reported Outcomes Measurement Information System (PROMIS) upper extremity (UE) v1.2 were evaluated in patients with early-stage carpometacarpal (CMC) osteoarthritis (OA). We hypothesized that in patients with early CMC OA, PROMIS UE scores would: (1) be lower than those in asymptomatic controls; (2) correlate with established patient-reported outcomes; (3) correlate with pinch and grip strengths; and (4) not correlate with radiographic disease progression.

Rates of and Risk Factors for Trigger Finger after Open Carpal Tunnel Release.

 We have anecdotally noticed a higher rate of trigger fingers (TFs) developing in patients who have undergone carpal tunnel release (CTR).  Is the rate of TFs after CTR greater compared to the nonoperative hand? Is the thumb more commonly involved postoperatively compared with spontaneous TFs? Do particular associated comorbidities increase this risk?  We queried our institutional database for patients who had undergone open CTR during a 2-year period and recorded the development of an ipsilateral TF after a CTR or a contralateral TF in the nonoperative hand. Patient demographics, comorbidities, concurrent initial procedures, time to diagnosis, and finger involvement were recorded.

Medical Product Development Part 2: Patent and FDA Issues.

In part 2 of this review series on how to engage with the medical device industry as a surgeon, we summarize the patent application process. The federal government must approve any invention you might try to bring to market as safe-to-use for patients before any marketing can be initiated via the Food and Drug Administration submission process detailed herein.

Total Wrist Arthroplasty Alignment and Its Potential Association with Clinical Outcomes.

 There is a lack of quantitative research that describes the alignment and, more importantly, the effects of malalignment on total wrist arthroplasty (TWA). The main goal of this pilot study was to assess the alignment of TWA components in radiographic images and compare them with measures computed by three-dimensional analysis. Using these measures, we then determined if malalignment is associated with range of motion (ROM) or clinical outcomes (PRWHE, PROMIS, QuickDash, and grip strength).

Medical Product Development Part 1: Idea, Partnerships, and Commercialization.

The global orthopedic devices market is expected to reach nearly $72 billion by 2026, representing 12% of the projected global medical devices market. The vantage point of surgeons conveniently places them at the crossroads of surgery, therapy, and inpatient and outpatient dynamics, providing fertile ground for the invention of medical devices. This review article aims to provide an overview for how surgeons should take on launching a product in the medical device industry.

Biomechanics of the Distal Radioulnar Joint During In Vivo Forearm Pronosupination.

 Ulnar variance (UV) and center of rotation (COR) location at the level of the distal radioulnar joint (DRUJ) change with forearm rotation. Nevertheless, these parameters have not been assessed dynamically during active in vivo pronosupination. This assessment could help us to improve our diagnosis and treatment strategies.

Treating Pain With Open-Label Placebos: A Qualitative Study With Post-Surgical Pain Patients.

Prior research has shown that Open Label Placebos (OLPs; that is, placebos described honestly as inactive pills) are effective for a variety of clinical conditions, including pain. However, little is known about patient attitudes towards OLPs. We conducted qualitative interviews with n = 11 patients (73% female) who recently had hand or wrist surgery and took ≥ 1 opioid pill.

In vivo articular contact pattern of a total wrist arthroplasty design.

Total wrist arthroplasty (TWA) designs suffer from relatively high complication rates when compared to other arthroplasties. Understanding the contact pattern of hip and knee replacement has improved their design and function; however, the in vivo contact pattern of TWA has not yet been examined and is thus the aim of this study. We hypothesized that the center of contact (CoC) is located at the geometric centers of the carpal component and radial component in the neutral posture and that the CoC moves along the principal arcs of curvature throughout primary anatomical motions.

Implant Charge Differences Between Distal Radius Fixation Constructs (CPT 25607, 25608, and 25609).

Background: Implants are a significant contributor to health care costs. We hypothesized that extra-articular fracture patterns would have a lower implant charge than intra-articular fractures and aimed to determine risk factors for increased cost.

Methods: In total, 163 patients undergoing outpatient distal radius fracture fixation at 2 hospitals were retrospectively reviewed stratified by Current Procedural Terminology codes.

The Association of AUSCAN and PRWHE Patient-reported Outcome Measures With Radiographic Progression of Early Thumb Carpometacarpal Arthritis at 36-Month Follow-up Is Limited to Subtle Changes in the Pain Subscale.

Background: There is a paucity of literature that examines how patient-reported outcomes correspond to early radiographic progression of thumb carpometacarpal (CMC) osteoarthritis (OA). This study examines how Australian/Canadian Osteoarthritis Hand Index (AUSCAN) and Patient-Rated Hand and Wrist Evaluation (PRWHE) scores change over 36 months in subjects with early CMC OA.

Methods: Ninety-one subjects with symptomatic early thumb CMC OA were enrolled.

The Weekend Warrior: Common Hand and Wrist Injuries in Athletes.

Weekend warriors are individuals who condense their weekly physical activity into extended intervals over one or two days.1 Excessive physical activity can result in a multitude of overuse and traumatic upper extremity injuries. The purpose of this review is to highlight the etiology and management of the more common hand and wrist injuries in athletes.

Characteristics and Publication Rates for Podium Presentations at National Hand Surgery Meetings from 2007 to 2012.

The purpose of this study was to evaluate and compare the research presented at the annual meetings of the American Society for Surgery of the Hand (ASSH) and the American Association for Hand Surgery (AAHS). Podium presentation data were extracted from the abstract books of the annual meetings of the ASSH and AAHS from 2007 to 2012. Corresponding publications were identified using searchable online publication databases and an algorithm linking authorship and content.

Proximal-distal shift of the center of rotation in a total wrist arthroplasty is more than twice of the healthy wrist.

Reproduction of healthy wrist biomechanics should minimize the abnormal joint forces that could potentially result in the failure of a total wrist arthroplasty (TWA). To date, the in vivo kinematics of TWA have not been measured and it is unknown if TWA preserves healthy wrist kinematics. Therefore, the purpose of this in vivo study was to determine the center of rotation (COR) for a current TWA design and to compare its location to the healthy wrist.

The Intersection of Hand Surgery Practice and Industry.

This article focuses on the working relationship between practicing hand surgeons and company representatives. The basic job of reps is to influence surgeon behavior to use their products. Surgeons must make certain that nothing of value is received in a quid pro quo for using industry products.